Cognitive bias

Many stutterers suffer from social anxiety disorder. The only evidence-based treatment for social anxiety disorder in stutterers is Cognitive Behavioral Therapy (CBT), which must be provided by a therapist, is lengthy, expensive, and has mixed results. CBT has high cognitive demands for controlled and deliberate processing of threats, on top of most stuttering therapies having high cognitive demands to monitor and control one’s speech motor movements. Paying attention to one’s processing of threats while paying attention to one’s breathing and vocal fold control while paying attention to a conversation can be too much mental effort in real conversations, outside of a speech clinic.

Cognitive Bias Modification (CBM) has been shown effective in treating social anxiety disorder. It’s computer-based and doesn’t involve a therapist. In a typical CBM treatment for social anxiety disorder, a computer screen is divided between a lively party on one side and a quiet garden on the other side. Letters appear on the screen, and users have to type the letters as they appear. At first, the letters appear mostly on the quiet garden side. Over time, letters appear more on the lively party side. The response time between letters appearing and the user’s response is analyzed. A long response time for letters on the lively party side indicates that the user is avoiding looking at the party, and is experiencing social anxiety. In this case, the program will continue to display the letters mostly on the quiet garden side. But a shortening response time for the lively party side indicates that the user is becoming comfortable looking at the party. If so, then more letters will appear on the party side. When there is no difference between response times between the two sides of the screen, the user has finished this stage of the treatment.

In the study Cognitive bias modification for social anxiety in adults who stutter, by Jan McAllister and colleagues, subjects viewed a pair of pictures of an individual. In some pairs, both pictures had a neutral expression. In other pairs, one picture was a neutral expression and the other was a disgusted expression, i.e., what a listener might express upon hearing the subject stutter. The faces were displayed for 500 milliseconds, and then replaced with either an E or an F in place of one of the faces. The subjects then had to type the letter as quickly as possible.

The task was online (CBSTrials.com) and performed at home. Sessions were five minutes, twice a week, for four weeks; or forty minutes total.

31 adult stutterers started the treatment. 17 of these subjects (55%) met the criteria for social anxiety disorder. This prevalence is similar to other studies of social anxiety disorder in stutterers.

25 subjects (80%) completed the treatment. The subjects also completed six psychological tests and one speech fluency test; before treatment, at five weeks, and at four months. The treatment subjects’ speech improved, from 9.4% stuttered syllables to 8.4% and then to 7.9%, or a 16% reduction in stuttering. The control group had no speech improvement.

All six psychological tests showed improvement in the treatment subjects, with less or no improvement in the controls. In five of the six tests, the four-month score was better than the five-week score, and in the sixth test the five-week score and the four-month score were close. This suggests that the treatment produces long-lasting results. The results ranged from 12% to 24% improvement.

Overall, these results are impressive, given that the treatment took only forty minutes and was done online. It’s interesting that fluency improved even though no speech therapy was provided. Apparently improved psychological outlook improves the speech of stutterers.

 
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